Provider Demographics
NPI:1104526516
Name:BENNETT, SARA (RPH, PHARMD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:CROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 BRUCE DR
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-5429
Mailing Address - Country:US
Mailing Address - Phone:706-302-9030
Mailing Address - Fax:
Practice Address - Street 1:414 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3676
Practice Address - Country:US
Practice Address - Phone:478-237-3524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH034154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH034154OtherGA BOARD OF PHARMACY PHARMACIST LICENSE NO.
GA1259484OtherNABP NUMBER